Tag Archives: global surgery

As l read Lifebox chair and co-founder Atul Gawande’s editorial published in the Lancet Commission on Global Surgery I am reminded of this moment: our part in a global chain reaction sparked in desperate response to the challenges faced by Dr Shrikant Jaiswal, first and only anaesthetist at Umarkhed Hospital in India.

Umarkhed is the closest hospital to the rural village where Atul’s father grew up. It serves a community of over 60,000 people in the town and a quarter million others in surrounding areas, and, as he wrote in a recent Lancet article “like so many hospitals in low-income settings, [it did] not have essential monitoring systems – even just a pulse oximeter.”

Pulse oximeters are the single most important monitors in modern anaesthesia, allowing healthcare workers to ensure their patients are adequately oxygenated and stable. The Lancet Commission on Global Surgery, a year-long, collaborative research effort into the issue chose pulse oximetry as a proxy measure for safety in surgery: it’s a machine with enormous practical and symbolic value, and a key component of Lifebox’s safer surgery work.

“Listening to Dr Jaiswal on the phone, I realised that for all the communities Lifebox had helped, we had not helped the community where my own family had come from,” Atul wrote in the Lancet.

“How fast could we get three oximeters to reach the frontline in India?” he wrote to us.

This moment also represents team work – it shows how a small group of people working together in a shoebox office in London respond to the needs of medical professionals, like Jaiswal, all over the world.

Since 2011, Lifebox has distributed nearly 9000 pulse oximeters to hospitals in 90 countries – working with anaesthetists, surgeons and healthcare professionals across low and high resource settings to ensure that more communities have access to safer surgery.

When Atul’s email came in, the next step was to pass on to Lifebox Procurement Manager, Remy Turc. Remy handles the distribution of pulse oximeters, ensuring that this essential piece of monitoring equipment makes its way from our manufacturer in Taiwan, to hospitals in low resource settings.

“I gave Lifebox Jaiswal’s address and made a donation for three oximeters to be delivered,” explained Atul.

Thanks to a collaborative effort, in just over a week Jaiswal received the three pulse oximeters he so desperately needed in order to provide life-saving treatment – one for the operating theatre, one for the labour ward and one for the recovery room.

His story powerfully demonstrates the changing global health landscape. For the first time in history you’re more likely to be killed by a surgically treatable condition than a communicable disease; but in low resource settings surgery can be a challenge to access and desperately unsafe.

The recent launch of the Lancet Commission on Global Surgery, culminating in a report that aims to put the problems of essential surgery at the heart of the global health agenda offers a rallying call – Universal access to safe and affordable surgical and anaesthesia care for all when needed.

According to this report five billion people cannot access safe surgery when they need it, with 33 million others facing catastrophic expenditures paying for surgery and anaesthesia annually.

There are huge challenges ahead but the dedication of people like Jaiswal is what keeps us going here at Lifebox. We are committed to the distribution of essential monitoring equipment, education and training – to saving lives though safer surgery.

“In every aspect of life, the phrase ‘the more you learn, the more you realise how little you know’ seems to ring true – yet in the context of volunteering with Lifebox on my gap year, it has never felt more apt. I came to the office vaguely conscious of my naivety: fresh from sixth form, the notion of working in global health was appealing and, eagerly armed with my copies of “Half the Sky” and “Mountains Beyond Mountains”, I was keen to learn.

Nearly six months down the line, while my knowledge has increased, I’m also increasingly aware of my limited understanding of global health’s huge economic, social and political facets. My eyes have been opened to the challenges of trying to make a difference, although I’m sure I’ve yet to fully appreciate the scale of these challenges.

Each week I’ve been lucky enough to see behind the scenes of an international charity – the nuts and bolts of an organisation successfully delivering equipment and education to remote hospitals around the world, all conducted from a small office in central London.

Communicable diseases – HIV/AIDS, TB, malaria – tend to get a lot of media coverage, while non-communicable diseases and the global surgery crisis are rarely given attention. I was unaware of unsafe surgery’s significance for billions of individuals around the world until I started to volunteer with Lifebox; a position many of the general public are still in. Considering the magnitude of the problem, it is a travesty global surgery doesn’t receive more coverage.

Lifebox has exposed me to the virtual global health community, and seeing what people are thinking, saying, and then actively going and doing, is really inspiring. Social media is undoubtedly a useful tool for raising awareness and making connections, and it has been great seeing the likes of Facebook and Twitter being used for something other than posting selfies and pictures of cats (lovely though they are).

I’ve volunteered with Lifebox through a busy few months – 8th March was International Women’s Day, which saw the wider launch of Lifebox’s “MAKE IT 0®” campaign, and I felt privileged to overhear some of the interviews taking place, interviews which went on to build the striking online compilation of real women’s experiences with surgery. An equal privilege was being able to help out at Lifebox Day, an exciting event in January which saw the gathering of many motivational safe surgery advocates, sharing their experiences of practice in low resource areas and ideas for how to move forward.

Volunteering with Lifebox has been such a valuable, inspiring experience for me. I start medical school in September and really hope to pursue this area of healthcare further – the option to intercalate with a BSc in Global Health is definitely looking appealing at the moment. While there is still an appalling disparity in access to safe surgery globally, the determination of passionate individuals fighting for change is promising; one thing I’ve definitely learned is that there really is infinite possibility for progress.”

Robyn Evans spent six months as a volunteer with Lifebox Foundation. She is currently volunteering with Orion and will be starting medical school later this year.

“We’re here today to talk about surgery,” said Lord Bernard Ribeiro, vice chair of the All Party Parliamentary Group (APPG) on Global Health, as he welcomed the audience to the Houses of Parliament yesterday. “Not as a luxury, but as something that changes lives.”

Past the policemen, across Westminster Hall and over the commemorative plaques marking where Charles I was tried and Winston Churchill laid in state – such rarified air and elegant sandwiches might seem an unlikely setting to talk about the 2 billion people around the world who lack access to essential surgical care.

But for the first time in history more people are dying from surgically-treatable conditions than infectious diseases. The arrow keeps going up, and global surgery is utterly failing to keep pace.

“People are dying unnecessarily, and with great suffering,” said Michael Cotton, surgeon, co-founder and chair of the International Collaboration for Essential Surgery (ICES). “It’s not necessarily complicated or expensive to deliver essential surgery, it’s a cost-effective, one-off intervention with life-long results. These are the things that really need to be done.”

Global surgery is in crisis and it’s time for global action. It’s a thrilling step that politicians and Lords are crossing party boundaries to open the hallowed doors and talk about it.

To talk and to listen. The APPGs on Global Health and on Population, Development and Reproductive Health joined forces to host a screening of The Right To Heal, the documentary by surgeon and ICES co-founder Jaymie Henry that puts the spotlight on the people whose lives are wrecked by lack of access to safe and timely surgical – and those who are working to change this.

“I grew up in the Philippines, and have first-hand experience of lack of access to healthcare. But working in ‘global surgery’ felt increasingly like an idealistic, academic experience. We were looking at it through a second-hand lens,” Jaymie explained to Lifebox in an interview for the Make It Zero campaign on International Women’s Day.

“I started traveling, and meeting people, talking about their experience of not having access to something so vital. And I thought the gap was really just about letting people know. We become complacent knowing everything for us is working well. But how can you be a human being and stand by, not do something about it?”

Watching Priscilla, a young student in Kenya, talk about her experience of rape, obstructed labour and the resulting obstetric fistula, it feels criminal not to.

But global surgery has been on the agenda – and largely ignored – for more than 30 years. It needs infrastructure, training, equipment and education – and it needs us to make more noise.

This was a room full of leaders in the field – the Royal Society of Medicine (RSM), the Association of Anaesthetists of Great Britain and Ireland (AAGBI), The George Institute, Tropical Health and Education Trust (THET), and The Lancet which has just hosted the first meeting of its commission on global surgery – asking each other what can we do, what do we do next.

The answer isn’t clear, but the imperative is – and as Right To Heal continues its journey across the medico-festival circuit, with screenings across continents – and of course Lifebox Day earlier this year – it’s exciting to hear the response, the urgency, the conversation getting louder.

With the MDGs expiring in 2015 it’s a vital time to get surgery on the international agenda. We’ll leave the politics to our hosts, but it seems to us it’s good sense and good rhetoric: lack of access to safe surgery is a global health crisis, but unlike polio or HIV, surgery is its own solution too.

“Surgery is as important as infectious diseases in public health,” says Agnes Binagwaho, the Rwandan Minister of Health in the film. “How can you save someone from HIV only to let them die in a road traffic accident?”

When two global surgery events come along at once you don’t grumble. Unlike a bad bus day, you get on board!

As Lifebox chairman, surgeon, author and casual time traveler Atul Gawande (bodily in Boston and telegenically in London) explained by video, “the global health landscape is changing. For the first time in history, you’re more likely to be killed by a surgically-treatable condition than a communicable disease.”

The struggle to activate a response to this shift has precedence: the WHO Global Initiative for Emergency and Essential Surgical Care (GIEESC) launched in 2005, the Bellagio Essential Surgery Group convened in 2007.

Still, our ‘neglected stepchild’ is dangerously out of synch with global need. As the MDGs count down to expiration in 2015, the need to act is clear and urgent.

So this past weekend we kept one eye on the live stream as the world’s best minds gathered in Boston for the first meeting of the Lancet Commission on Global Surgery, and another on the world’s other best minds, gathered in London for Lifebox Day!

More than 60 colleagues with an interest in global surgery swapped a rare sunny Saturday for a darkened room in the Camden People’s Theatre. Never mind the artificial light: the right speakers and the right conversation let in the great wide world, and we were thrilled to join such a passionate, thoughtful, global group, looking to make noise about a silent crisis.

We were in good company! Atul introduced our patron Lord Bernard Ribeiro, past president of the Royal College of Surgeons, who reminisced about being (gently) strong-armed into joining the Lifebox mission.

“It just goes to show that surgeons and anaesthetists can learn from each other,” he said, introducing with a lordly smile the broadest theme of the day: trust.

Trusting you with my story.

Trusting you with my patients.

Trusting you with my life.

A permanent improvement in the safety and quality of surgical care in low-resource settings doesn’t happen overnight – and why should we expect it to? Like anything in life, long-term solutions take long-term commitment.

“You must invest your time in this,” explained Dr Stephen Ttendo, past president of the Ugandan Society of Anaesthesia “If you don’t gain trust, you will fail.”

This means confronting the brutal reality that universal solutions to universal problems don’t have universal application. As Dr Sophia Webster of Flight for Every Mother reminded us, all women are at risk from the same complications during pregnancy – but only in some countries do they die from them.

The obstetrician, recently returned from her solo flight across 26 countries in Africa to raise awareness of unsafe pregnancy, took the room on the journey with her.

The next speaker stayed in trajectory, swinging the NHS via NASA and heading for space. Anaesthetist, Extreme A&E and Horizon presenter Dr Kevin Fong‘s investigation of risk and how we learn from our errors made the audience laugh, sober up sharply, and then laugh again, but nervously this time – mistakes can seem so silly till they happen.

Fuel for ire and action – and probably time for lunch. Enter Chipotle, the only local restaurant to not only answer their phones in friendly style, but enthusiastically agree to sponsor lunch at Lifebox Day! A grateful dash to the Mexican grill’s Wardour Street branch and we were back with 70 burritos – a very practical conference snack as it happens.

Another generous donation from our friends in the north at Thomas Tunnock Ltd kept the room sweet through tea time.

Doctors and nurses spend their days on close terms with life and death – no wonder they make powerful poets and writers, and we were so pleased to see the Lifebox crowd in strong metre! Poems took the top three spots in the Lifebox Competition, and second prize winner Emily Lear was on hand to read her submission.

Maybe it was the theatrical setting but somehow the words “champagne coloured wee” never sounded so dramatic, while the last couplets –

But if the worst happens, if things aren’t as planned / If you find yourself holding a relative’s hand: / It is those humble numbers which helped us to say / We did all that we could and in just the right way.

– reminded the room, in ways that statistics make it easier to forget, that unsafe surgery is a tragedy – and a burden of grief that isn’t fairly shared.

The human cost of lack of access to safe surgery worldwide was given an unflinching, high definition focus in a new documentary: The Right To Heal, directed by surgeon Jaymie Henry, and screened at Lifebox Day for only the second time in the U.K.

Dr Henry, born in the Philippines, spoke with passion and experience about what she and her team have seen on the road, camera in hand. Her subjects appeal for attention – and trust enough to tell you their stories. The 15 x 15 Campaign is one of the ways that Jaymie and her colleagues at the International Collaboration for Essential Surgery (ICES) are working to make good on that decision.

Lifebox was founded in 2011 to make surgery safer in countries where lack of equipment and training means that undergoing a life-saving operation is, perversely, one of the most dangerous thing to do.

We left Lifebox Day as airborne as Sophia and Kevin’s flightmobiles, after a day in company that is striving to support a world where access to safe surgery is a right, not a privilege. Thanks to team efforts, this largely silent global health crisis is starting to make noise.

As Omiepirisa Yvonne Buowari, a Nigerian anasthetist and one of the competition winners wrote,

Team work is good. / We can beat our chest and say / Together, each achieves much.